Oesophageal carcinoma is a rising global health burden, with surgical resection and perioperative chemotherapy forming the cornerstone of curative treatment. However, uncertainty persists regarding the optimal surgical approach, partly due to heterogeneity in outcome reporting, which hinders data synthesis and evidence-based decision-making. To address this, a core outcome set (COS) for oesophageal cancer surgery was developed through international consensus among clinicians and patients. This study systematically evaluates the uptake of these core outcomes in contemporary surgical research. A systematic review was conducted of randomised controlled trials and prospective cohort studies investigating oesophagectomy for oesophageal cancer, published between 2010 and 2024. The reporting of ten COS-recommended outcomes was assessed across eligible studies. Fifty-eight studies involving 22 260 patients were included (39 cohort studies; 19 RCTs). No study reported all 10 core outcomes. The median number of core outcomes reported was 4 (interquartile range 3-5). The frequency of individual core outcome reporting was as follows: in-hospital mortality (86%), conduit necrosis/leak (81%), respiratory complications (79%), overall survival (30%), ability to eat and drink (44%), quality of life (26%), inoperability (23%), reflux symptoms (21%), severe nutritional effects (19%), and need for reintervention (16%). No improvement in core outcome reporting was observed over the study period. Promoting COS implementation and improving methodological rigour is essential to ensure that future research reflects the priorities of both clinicians and patients, and facilitates meaningful evidence synthesis.

BackgroundFeeding jejunostomy (FJ) provides critical enteral access for patients undergoing treatment for upper gastrointestinal (GI) pathology. This study aimed to evaluate the safety, complication profile, and operative context of laparoscopic versus open FJ using a standardised laparoscopic technique.MethodsA retrospective cohort study included 576 patients who underwent FJ between March 2018 and August 2024 (302 laparoscopic, 274 open). Patient demographics, operative context, and postoperative complications were analysed. Outcomes are reported as frequencies with relative effect estimates and corresponding 95% confidence intervals.ResultsBaseline characteristics were comparable between groups. Laparoscopic FJ was more frequently performed in the elective setting (286/302 vs. 225/274; OR 3.88, 95% CI 2.20-6.85) and during cancer staging procedures (102/302 vs. 50/274; OR 2.28, 95% CI 1.55-3.37). In contrast, laparoscopic FJ was less commonly undertaken during major resections (156/302 vs. 165/274; OR 0.71, 95% CI 0.51-0.98) and emergency surgery (16/302 vs. 49/274; OR 0.25, 95% CI 0.14-0.45). On unadjusted analysis, overall postoperative complications were more frequent following laparoscopic FJ (43/302, 14.2%) compared with open FJ (18/274, 6.5%); however, after adjustment for comorbidity burden, procedural urgency, and other clinically relevant covariates, surgical approach was not independently associated with postoperative morbidity (adjusted OR 1.25, 95% CI 0.75-2.05). Tube-related complications, including dislodgement, leakage, and small bowel obstruction, were infrequent. Lower body mass index and female sex were associated with increased odds of obstruction. Early infectious complications occurred exclusively following laparoscopic FJ (5/302, 1.7%), but this association did not persist after multivariable adjustment (adjusted OR 2.60, 95% CI 0.75-9.10).ConclusionLaparoscopic FJ was a safe alternative to open insertion. Although unadjusted complication rates were higher following laparoscopic FJ, surgical approach was not independently associated with early morbidity after risk adjustment, supporting the use of minimally invasive techniques in appropriately selected patients.

Bariatric surgery is an effective treatment for obesity. This study aims to identify demographic factors of weight loss and recurrent weight gain over a 10-year follow-up period. This retrospective observational study includes 2092 patients for overall trends, 1032 patients for predictors of weight loss, and 605 patients for predictors of recurrent weight gain. Percentage total weight loss (

Long-term outcomes of Roux-en-Y gastric bypass (RYGB) in adolescents are limited. This systematic review and meta-analysis evaluates the safety and efficacy of RYGB in adolescents with obesity. A comprehensive literature search was conducted across databases, including MEDLINE, EMBASE, Cochrane, and SCOPUS up to July 2023. Included studies reported outcomes for participants younger than 21 years of age undergoing RYGB, with a minimum follow-up of 2 years. A random-effects model was used for pooled analysis. Twelve studies were included involving 522 adolescents. The mean age was 17.5 years (13-21 years), 73.6% of patients were female, and the mean follow-up was 48.4 months. Baseline body mass index (BMI) was 50.1 kg/m2. BMI reduction peaked at 1 year with an absolute reduction of 19.1 kg/m2, 36.6% total loss, and 67.7% excess BMI loss. At 5 years, absolute reduction of BMI was 19.1 kg/m2, percentage loss was 31.5%, and excess BMI loss was 70.5%. Comorbidity remission rates were 85% for dyslipidemia, 73% for hypertension, 85% for type 2 diabetes, and 68% for obstructive sleep apnea. Iron and vitamin B12 deficiency rates were greater postoperatively. The complication rate was 29.1%. RYGB in adolescents leads to significant weight loss and comorbidity resolution but carries risk of complications and requires monitoring for nutritional deficiencies. Further long-term studies are essential.

BACKGROUND:The development and use of core outcome sets (COSs) have the potential to inform best practice in healthcare treatment options by facilitating data synthesis across studies. In surgical oncology, eight cancer-specific COSs exist, and these overlap in content. The development of a meta-COS that includes the core outcomes from existing cancer data sets would be applicable, as a minimum, across all cancer types in surgical oncology for use in effectiveness trials and clinical practice. METHODS:The process of developing a meta-COS included identification of the existing COS and their discussion with 3 different stakeholder focus groups (surgeons/oncologists, other healthcare professionals, and patients and carers). Outcomes were identified through a review of the literature and registered clinical trials. Stakeholders representing healthcare professionals (surgeons/oncologists and others) were recruited from national societies, regional cancer networks, and local trial centres, whereas patients and carers were recruited using independent representative organizations. The aim was to include at least two individuals from each group for the ten common cancers requiring surgery. These ten cancer types were regarded as the commonest based on global incidence in World Cancer Research Fund data. An agreed-upon list of outcomes was scored in a two-round online Delphi survey (March-May 2025). The results of this survey were discussed and ratified at an online consensus meeting (June 2025) by Delphi participants who completed both rounds, members of the stakeholder groups, and patients. The 80% threshold defined consensus. RESULTS:Forty-five participants completed both survey rounds, and 15 participated in the consensus meeting. Of 317 outcomes initially identified, 35 were discussed with stakeholders, 32 were scored in Delphi rounds, and consensus was achieved on eight core outcomes to include in the surgical oncology meta-COS: overall survival, disease-free survival, disease-specific survival, death related to surgery, delay to further treatment, completeness of tumour removal, overall quality of life, and serious adverse events. CONCLUSION:This meta-COS for surgical oncology offers a standard set of outcomes to be used in surgical oncology studies and clinical practice, regardless of cancer type.

Patients who experience a significant response to neoadjuvant FLOT chemotherapy have been reported to enjoy a better five-year survival. This service evaluation aims to determine the clinicopathological factors association with pathological tumour regression gage (TRG) in patients undergoing oesophagectomy for adenocarcinoma of the oesophagus. Patients undergoing oesophgaectomy between 2018-2024 were studied. Clinicopathological factors includes demographics (age and gender), tumour stage, differentiation, and TRG, all reported by a consultant pathologist at the time of surgery. Associations were examined using chi-squared test and both log-rank and Cox regression analysis for survival. One hundred and fifty eight patients underwent oesophagectomy following neoadjuvant FLOT chemotherapy during the study period. 28 (16.7%) of patients experience a good response (Mandard grade 1 and 2). A higher proportion younger (<65 years) patient was observed in the poor tumour regression grade group (51.2% vs. 28.6%, p=0.027). Tumour stage, differentiation and gender were not associated with TRG. During the follow-up period, 50 patients died and median survival was not reached. On Cox proportional-hazards regression analysis, poor TRG was associated with poorer overall survival (Hazard Ratio 4.61 (95% CI 1.43-14.83; p=0.010). On multivariable regression analysis, poor TRG was not independent of ypTNM stage (HR 2.03, p<0,001) or poor differentiation (HR 1.47, p<0.001). Poor TRG was seen more commonly in younger patients. Clinicopathological factors do not appear to be significant determinants of tumour response, and the molecular basis of chemotherapy resistance needs to be studied.

Obesity is causally linked to CAD and HF directly by triggering various adverse pathophysiological changes and indirectly by promoting convergent risk factors such as diabetes, hypertension, dyslipidemia, and sleep disorder. Weight reduction is an important intervention for obesity-related cardiomyopathy and antiobesity medications that target both obesity and HF, particularly SGLT2 inhibitors and GLP-1RAs, have a major role in treatment. Bariatric surgery offers a viable treatment option for patients with severe obesity associated with CAD and HF but requires careful patient selection, preoperative optimization, choice of procedure, and postoperative management to minimize risks and achieve successful outcomes.

Background Understanding outcomes of surgery performed with curative intent for different cancer types allows comparisons to be made provided consistent outcomes are selected and measured. At present core outcome sets (COS) that represent the minimum outcomes measured and reported in any clinical trial for a given condition exists for six of the ten most prevalent cancer types but it is uncertain whether this can be used to inform the development of a meta-COS (core outcome set) for any cancer type requiring a surgical operation with curative intent. This paper describes our study protocol to develop a meta-COS for surgical oncology. Methods Three stages of work will be conducted : (1) identification of a long list of outcomes including adverse events from previously published COS, a review of outcomes from trials registered with ClinicalTrials.gov, and focus groups with key stakeholders (inclusive of cancer patients having undergone surgery with curative intent for cancer or carers of such patients); (2) a two-round online Delphi survey including clinicians, patients or carers, and allied health professionals (such as dietitians, specialist nurses, physiotherapists, occupational health workers) to prioritise the outcomes; (3) an online consensus meeting using to agree on the final meta-COS. Discussion The meta-COS for surgical oncology trials will ensure that a selection of relevant outcomes will be available for use in all research studies for any cancer type requiring a surgical intervention. Registration This study titled “A meta-Core Outcome Set (COS) for surgical oncology” is registered on the COMET (Core Outcome Measures in Effectiveness Trials) Initiative database. (https://www.comet-initiative.org/Studies/Details/3252).

AIMS:Estimation of post-bariatric surgery weight loss is important for informed clinical decisions, yet existing predictive models lack accuracy and reliability. We assessed the effectiveness of the validated Stratification of Obesity Phenotypes to Optimize Future Therapy (SOPHIA) bariatric weight trajectory prediction tool in our patient population. MATERIALS AND METHODS:We conducted a retrospective study of 178 adults who underwent bariatric surgery over a 3-year period. Actual weights at baseline and annually over 5 years of follow-up were compared with predicted weights to calculate mean difference and median absolute deviation (MAD). RESULTS:The study comprised 157 women (88.2%) and 21 men (11.8%) with mean (standard deviation) age of 46.9 (10.6) years and baseline weight of 138.4 (23.5) kg. The bariatric surgical procedures included 148 (83.1%) gastric bypass, 19 (10.7%) sleeve gastrectomy and 11 (6.2%) gastric band operations. The proportion of patients with actual weights within the prediction interquartile range (IQR) was 50.7%, 43.2% and 38.8% at 12, 24 and 60 months, respectively. The mean difference between actual and predicted weight at 60 months was 0.6 (16.7) kg, p = 0.654 (paired t test). The mean MAD at 60 months was 12.9 (95% CI, 11.3-14.4) kg, indicating moderate predictive utility. The predictive accuracy was highest for gastric bypass. Subgroup analysis revealed greater accuracy in patients without diabetes/pre-diabetes, and in nonsmokers. CONCLUSIONS:The SOPHIA study tool provides accurate postoperative weight forecasts for some subgroups of patients, but its precision diminishes with time. This study reiterates the necessity for better personalized weight prediction tools to inform bariatric surgery decision-making.

Patients with adenocarcinoma of the oesophagus commonly suffer with anaemia. This service evaluation aims to determine the character of the anaemia, its association with common clinicopathological factors and survival in patients undergoing oesophagectomy for adenocarcinoma of the oesophagus. Patients undergoing oesophgaectomy between 2018-2024 were studied. Clinicopathological factors includes demographics, tumour stage, differentiation, tumour regression, and markers of the systemic inflammatory response (CRP, Neutrophil-Lymphocyte Ratio, and Platelet-Lymphocyte Ratio). Associations were examined using chi-squared test and both log-rank and Cox regression analysis for survival. One hundred and sixty eight patients underwent oesophagectomy during the study period. 35 (20.8%) patients were anaemic of which 25 (71.4%) were normocytic and 9 (25.7%) were microcytic. Females were more likely to be anaemic (25.7% vs. 12.0%, p=0.044) when compared with males. Anaemia was not associated with tumour stage, differentiation, nor markers of the systemic inflammatory response. During the follow-up period, 52 patients died and median survival was not reached. On log-rank analysis, anaemia was not associated with overall survival (p=0.960). Although one fifth of patients were anaemic at presentation, this was not associated with longer-term survival. The majority of patients were normocytic, possibly reflecting an anaemic of chronic disease and other treatment avenues, beyond iron, may be required.

Hospital-acquired pneumonia (HAP) is a common and challenging complication following esophagectomy, with definitions that vary widely across clinical and research settings. The Centres for Disease Control and Prevention (CDC) criteria are endorsed by international consensus groups as a reference standard, but their relevance in postoperative surgical populations remains uncertain. This study aimed to assess the diagnostic performance of alternative criteria, including the American Thoracic Society (ATS) guidelines, the Utrecht definition, and the Clinical Pulmonary Infection Score (CPIS), as well as clinical diagnoses made at our center, compared against the CDC definition. We conducted a retrospective review of all consecutive esophagectomies performed at a regional specialist center from 2014-2022. Data included patient demographics, comorbidities, imaging, and postoperative outcomes. The CDC criteria were used as the reference standard for HAP, against which the sensitivity and specificity of the ATS, Utrecht, and CPIS criteria, as well as clinical diagnoses, were evaluated. Among 460 patients, 223 (48.5%) were treated for HAP, but only 56 (12.2%) met CDC criteria. The ATS criteria demonstrated the highest agreement with the CDC definition (sensitivity 97.5%, specificity 92.0%), while the Utrecht and CPIS criteria showed lower specificity. Clinical diagnoses demonstrated high sensitivity (88.9%) but low specificity (50.1%) relative to CDC-defined HAP. The mean time to HAP diagnosis was 5 days (SD ± 3.7), and just over half of treated patients had positive sputum cultures. There is significant variability in HAP diagnosis following esophagectomy depending on which criteria are applied. Clinical diagnoses often exceed formal definitions, suggesting a risk of overdiagnosis and overtreatment. These findings support the need for tailored, consensus-based criteria to improve diagnostic accuracy, guide appropriate treatment, and enhance benchmarking across centers.

Background Long-term symptom burden and health-related quality-of-life outcomes after curative oesophageal cancer treatment are poorly understood. Existing tools are cumbersome and do not address the post-treatment population specifically. The aim of this study was to validate the six-symptom LASORS tool for identifying patients after curative oesophageal cancer treatment with poor health-related quality of life and to assess its clinical utility. Methods Between 2015 and 2019, patients from 15 UK centres who underwent curative-intent oesophageal cancer treatment, and were disease-free at least 1 year after surgery, were invited to participate in the study and complete LASORS and European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 questionnaires. Receiver operating characteristic curve analysis was used to examine the accuracy of the LASORS tool for identifying patients with poor health-related quality of life. Results A total of 263 patients completed the questionnaire. Four of the six LASORS symptoms were associated with poor health-related quality of life: reduced energy (OR 2.13 (95% c.i. 1.45 to 3.13)); low mood (OR 1.86 (95% c.i. 1.20 to 2.88)); diarrhoea more than three times a day unrelated to eating (OR 1.48 (95% c.i. 1.06 to 2.07)); and bloating or cramping after eating (OR 1.35 (95% c.i. 1.03 to 1.77)). The LASORS tool showed good diagnostic accuracy with an area under the receiver operating characteristic curve of 0.858 for identifying patients with poor health-related quality of life. Conclusion The six-symptom LASORS tool generated a reliable model for identification of patients with poor health-related quality of life after curative treatment for oesophageal cancer. This is the first tool of its kind to be prospectively validated in the post-esophagectomy population. Clinical utility lies in identification of patients at risk of poor health-related quality of life, ease of use of the tool, and in planning survivorship services.

BackgroundThe delivery of cancer services changed significantly during the COVID-19 pandemic. This study aimed to describe changes in presentations, assess the change in recommendations by the MDT during the pandemic, and describe the subsequent long-term impact of these changes on survival rates in patients with EG cancer.MethodsA retrospective cohort study was designed comparing three patient groups of those referred to EG MDT in the same 6-month period pre-pandemic (PP;2019) during the initial phase of the pandemic (P1;2020) and the year after the initial phase (P2;2021). The primary aim of this study was to describe and compare deviations from the standard of care across these three timeframes. Secondary outcomes included differences in the number of new cases with early and advanced oesophageal and gastric lesions, a comparison of survival rates among the groups, and an analysis of postoperative histopathology to identify any shifts in the tumour stage across the studied periods.ResultsA consistent demographic profile across these periods was maintained, but with a significant decrease in patient referrals during P1 (35.25% reduction from PP to P1 and 9.5% reduction from PP to P2), quicker 'time to treatment' during P1 (130.8 days in P1 vs 162 in PP and 178.9 in P2), and notable changes in treatment modalities. Additionally, we found an increased deviation from initial curative to palliative intent in the P2 group (6.4% changed in P2 vs 2.2% in PP and 3.5% in P2) primarily driven by disease progression. A further significant observation was the emergence of more aggressive tumour characteristics, particularly in the P2 group, albeit without a statistically significant difference in two-year overall survival rates among the groups (p-value 0.31).ConclusionThe COVID-19 pandemic significantly impacted oesophagogastric cancer care, with a reduction in patient referral rates during the initial pandemic phase and a subsequent increase in more advanced stage disease. Our findings from a major UK EG centre highlight accelerated treatment decision-making during the initial pandemic phase was possible and that standard of care was maintained. These insights provide valuable lessons for healthcare systems in managing cancer care during global health emergencies.

Abstract Background Gastrectomy remains the cornerstone of curative treatment for gastric cancer but is associated with significant risks of complications. This study aimed to explore the impact of service centralisation in Greater Manchester on outcomes following gastrectomy for cancer. Outcomes were compared against international benchmarks to evaluate impact of centralisation and identify areas for improvement. Method This was a retrospective study of all patients undergoing gastrectomy (total gastrectomy TG; partial gastrectomy PG) for cancer at a tertiary OG cancer centre between 2007-2022. Patients were allocated to three time periods (2007-2012; 2013-2018; 2018-2022). Regional centralisation took place in August 2018. Outcome selection was guided by a core outcome set for gastrectomy and international benchmarks including the GastroData consortium and the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Results 379 patients undergoing gastrectomy (TG; 201, PG; 172) were included. Median length of stay shortened (p=0.023) and median lymph node yield improved (p<0.001) following centralisation. This was consistent with findings from the DUCA audit. There was no difference in R0 resection rates (p=0.668), surgical reinterventions (p=0.717) or readmissions within 90-days (p=0.428) after centralisation. Whilst post-operative mortality improved (30-day 4.5% versus 0%; 90-day 5.4% versus 1.2%), this was not statistically significant (p=0.09). Conclusion Centralisation of surgical OG cancer services in our region resulted in improved short-term outcomes for patients undergoing gastrectomy. This may reflect a greater emphasis on standardised peri-operative surgical and pathology protocols. These findings were partly consistent with international benchmarks. Further evaluation of the impact on longer-term outcomes is required.

Background The EORTC QLQ-STO22 (QLQ-STO22) is a firmly established and validated measure of health-related quality of life (HRQoL) for people with gastric cancer (GC), developed over two decades ago. Since then there have been dramatic changes in treatment options for GC. Also, East Asian patients were not involved in the development of QLQ-STO22, where GC is most prevalent and the QLQ-STO22 is widely used. A review with appropriate updating of the measure was planned. This study aims to capture HRQoL issues associated with new treatments and the perspectives of patients and health care professionals (HCPs) from different cultural backgrounds, including East Asia.Methods A systematic literature review and open-ended interviews were preformed to identify potential new HRQoL issues relating to GC. This was followed by structured interviews where HCPs and patients reviewed the QLQ-STO22 alongside new issues regarding relevance, importance, and acceptability.Results The review of 267 publications and interviews with 104 patients and 18 HCPs (48 and 9 from East Asia, respectively) generated a list of 58 new issues. Three of these relating to eating small amounts, flatulence, and neuropathy were recommended for inclusion in an updated version of the QLQ-STO22 and covered by five additional questions.Conclusions This study supports the content validity of the QLQ-STO22, suggesting its continued relevance to patients with GC, including those from East Asia. The updated version with additional questions and linguistic changes will enhance its specificity, but further testing is required.

Abstract Background Bariatric surgery has been consistently demonstrated to provide effective long-term sustained weight loss and remission of several life-threatening conditions. The most common bariatric procedures undertaken globally include laparoscopic sleeve gastrectomy (SG) and gastric bypass2. These procedures are safe and have low associated mortality rates [0.05% SG, 0.09% single anastomosis gastric bypass (SAGB) and Roux-en-Y (RNYGB)]3. However, complications including staple line and anastomotic leaks can occur in up to 3% of patients and are associated with significant morbidity, thus requiring prompt identification and treatment4. Our study aims to analyse management of these leaks and establish an algorithm for our centre. Method This was a retrospective study of consecutive patients who experienced post-bariatric surgery leak between 2018 to 2024, in a regional tertiary bariatric surgery referral unit in the UK, serving a population of 5 million. The study included patients who underwent bariatric surgery in the UK or abroad (SG, RNYGB and SAGB), both primary and revision cases, and were subsequently diagnosed with post-operative leak. Patients were initially managed in our facility or referred to our centre for ongoing management of leak from other centres. Demographics, time to presentation, hospital length of stay (LOS), diagnostic investigations performed, and management approaches were analysed. Results 22 patients (8 bypasses, 14 sleeves) were included. Mean time to presentation from index surgery was 19.6 days and mean LOS was 43.6 days. Initial management included conservative (3), endo-vacuum therapy (EVT) (4), stent (1), surgical (14) [9 laparoscopy and 5 laparotomy]. Surgical management comprised 7 T-tube insertions, 1 Foley catheter, 2 primary repairs, 2 EVTs, 1 washout and drain, and 1 stoma formation. Three patients required no further intervention, six needed different management approaches and three required re-operations. 7 patients were readmitted following discharge. Resolution of leak was achieved in all cases. There was no 90-day mortality. Conclusion Management of postoperative leak following bariatric surgery is a complex issue, requiring early identification, adequate drainage and control of sepsis, and maintenance of nutrition. Successful management requires a proactive and aggressive approach, including early clinical suspicion. Access to a range of interventions to support a dynamic approach to management is critical. The sequence and choice of management of leaks should be individualised according to each patient’s clinical presentation and investigation findings. A combination of different management approaches is often required for successful treatment of leak. Multicentre studies are needed to move closer to a consensus on managing bariatric leaks.

BackgroundGastric cancer, a leading cause of cancer-related mortality worldwide, has seen limited improvement in survival over the past 3 decades. Surgical resection is the cornerstone of curative management but the optimal approach remains unclear. Decision-making is hindered by inconsistent outcome reporting limiting data synthesis between trials. International consensus between healthcare professionals and patients has formed a core outcome set to be reported as a minimum. We appraised outcomes previously reported.MethodsEvidence Based Medicine Reviews, MEDLINE, EMBASE and CINAHL were searched for randomised controlled trials (RCTs) and systematic reviews of RCTs during years 1995-2021. We searched trial registries for protocols of ongoing and future trials.ResultsNinety-nine articles from 64 studies and 69 trial protocols were included. No study reported all core outcomes: average reported per trial was 4 (interquartile range: 2). 'Serious' adverse events were reported by 98%, completeness of tumour removal by 85% and surgery-related death by 74%. Outcomes important to patients were reported least: quality of life (22%) and nutritional effects (15%). Defining outcomes and time frames used was variable.ConclusionsCritically important outcomes are poorly reported in the literature and the status has not improved in future trials. Further work is required to improve uptake.